Healthcare Provider Details

I. General information

NPI: 1376233700
Provider Name (Legal Business Name): DR. ABDELRAHMAN MOHAMED ZAGHLOUL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2023
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5969 E BROAD ST STE 303
COLUMBUS OH
43213-1539
US

IV. Provider business mailing address

5969 E BROAD ST STE 303
COLUMBUS OH
43213-1539
US

V. Phone/Fax

Practice location:
  • Phone: 614-626-8822
  • Fax:
Mailing address:
  • Phone: 614-626-8822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.028140
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRES.004589
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: